153. Three Things Every Postpartum Exercise Lover Should Know With Guest Laura Chambers

Turns out that the normal "okay to return to exercise" advice given at your six week postpartum check-up might not be the best fit. Connecting with your core is key and my guest today is an expert on that. Her name is  Laura Chambers from Peak Wellness. After having her own baby, she refused to accept the leaks and aches that everyone told her was "normal". She dug for answers and she's sharing them with you today.

Maximizing Recovery in the Postpartum Period Study

Say hi to Laura on Instagram @dr.laura_peakwellness
www.peakwellnesstn.com

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Read the full transcript here:

Welcome to the Breezy Babies podcast. This is episode 153. Three things every postpartum exercise lover should know. Could you use more confidence as a parent? Welcome to the happy place for boobs and babies. You're in good hands. Breezy babies is where we ease your transition into parenthood because it's a bumpy road. Am I right? I'm your host Bri the IBCLC. And if you'd like to make life as a parent more breezy, you're in the right place. I'm here to deliver small bite sized tips and tricks so you can crush your parenting and lactation goals. I'm honored to be on this journey with you. Let's go Hello, how are you so good to be back with you for another podcast episode My baby is down for naps. My phone is on Do Not Disturb. I am ready to chat with you. PS Did you know that if you have an iPhone, there is a lovely little button on your phone. That is a Do Not Disturb and you click that on and nothing comes through on your phone. It is one of the best things when I need to focus and get a little bit of work done. I hope you enjoyed the last couple of weeks of the podcast episode where we talked about alcohol and caffeine consumption while breastfeeding, we are going to change we're going to change gears a little bit for today's podcast episode for next week's as well because I have two amazing guests for you both today and next week it they're both going to be so good. Today I'm going to focus on postpartum exercise which is something that I have honestly focused on a little bit better. This last pregnancy that I had, honestly, I was very active through my entire pregnancy and even in the postpartum, you know period where I could be and there's still some things that looking back. I'm like, Oh, I could have changed that and done a little bit better. So even if you think you know everything about postpartum exercise, I guarantee you're gonna learn something new and helpful to Dame I first want to talk with you about a study that was done on recovery in the postpartum period. And then like I said, I do have a special guest for you that is an expert in this area, you're for sure gonna want to learn from her as she shares her top three tips on this topic. But before we get into that, I want to read off to you the latest podcast review on Apple. This is actually from Holly on my team. She's said this episode about being a mentor and having a mentee is so great. We need more IBCLCs in this world. I love learning and I love talking about lactation. I can't say enough how thrilled I am to be in this space working with the amazing breezy babies team and feeling confident and confident enough with doing private practice that I can now be a mentor. I love that so much Holly said that she listened to that podcast episode on being a mentor, which is a few episodes back, as she I think she said she listened to as she was driving to a lactation consultation. She recently got started with having her own mentor while she works. Her own mentee I should say while she works. And it has been working out so well. Holly has been killing it with her consultations, and has been working so hard. And I really love having her on my team. So thank you, Holly for leaving that review. I didn't even ask her to do that she just went and did it herself. Did you know that leaving review is just one simple way that you can help out a small business such as this one. It's fast, quick, free to do and makes such a huge difference for others who are looking to find this podcast as well. All right. Today I am going to read from you from a study called maximizing recovery in the postpartum period, a timeline for rehabilitation from pregnancy through return to sport. That's a long title. This this study was published in October of 2022. So fairly new, we love new studies in the lactation world. I will link the full study in the show notes because I'm just going to be pulling a little bit from it today because I don't want to spend too much time I want to I want to leave time for my special guests today. So if you want to go and read the full article yourself, you can just go to the show notes and click the link. But basically in this study, they talk about how staying active during and after pregnancy is so important not only for your body, while they talk specifically how important it is for your body in this study, but we also know how, how great it is for your mental health as well. So they talk about how, from a medical perspective moving during your pregnancy decreases your risk of things like gestational diabetes, preeclampsia, hypertension, depression, and then also prenatal and postpartum incontinence. They also talked about how physical activity has not been shown to increase your chances of things like having a baby with low birth, weight, miscarriage, or having perinatal mortality. So we know that it's good to move before and after your, your pregnancy. But as women, we aren't given a lot of guidance on how to do it or how exactly to return to exercise at the six week mark after giving birth. Now in the study, they even talked about how the six week postpartum check, that's kind of what we all assume, at least in the United States, is a good point to be cleared to return to exercise. However, in this study, they talk about how appropriate interventions can start even before that six week clearance from your OBGYN or your midwife. But it's really important that the type of exercise that you do before that six week mark has been tailored to you and what is safe for you to do during that time. They talk about how musculoskeletal exams are rarely performed. Even though pregnancy and delivery is a musculoskeletal event. There's a lot of changes that are happening to our entire musculoskeletal system, when we are both carrying a baby and after we deliver a baby. And yet a lot of times our doctors don't look at that and don't address that. And don't give us one on one advice that stead it's more of a hey, you've made it to six weeks, go ahead and start exercising. Now they talk about how some things that we could consider looking at that are really common in the postpartum period are things like musculoskeletal pain, urinary incontinence, right? Have you heard of this, everyone, it seems like it's like, oh, it's just normal to just pee your pants after you have kids.
That's not our that's not our norm that not our goal that we're that we're shooting for. So while that can be common, it's not normal. Some other things that can can often happen is abdominal separation, and even pelvic organ prolapse. Those are things that can make it really tricky to return to exercise after you have your baby. And in fact, in this study, they found that 1/3 of postpartum runners experience pain upon their return as well as some form of urinary incontinence. And again, a lot of times people are told, Oh, that's normal. But I'm here to tell you that's that's not our normal. So specific to the pelvic floor. They they talk about in the study how during labor and delivery pelvic floor musculature is stretched to 250% of its resting length during delivery. That's right, I said 250% is how much your pelvic floor is stretched during delivery. They talk about how the recovery of those pelvic floor MUFE muscles is thought to be maximized by four to six months postnatal, but they talk about how unrestricted clearance to activity is typically obtained. Well before this point, probably at that six week check in with your doctor right. They talk about how pelvic floor dysfunction including urinary stress, incontinence, urgency, overactive bladder, pelvic or organ prolapse, or fecal or anal incontinence is high with over one in four women experience at least one of those conditions. That's a lot. I also really liked this part of the study where they talk about high impact exercise and they found that it is found to increase the risk of pelvic floor dysfunction nearly five fold as compared to low impact exercise. So again, you might need some additional healing time before going back to your high impact exercise. That is One thing that I probably could have done a little bit better after having my fourth baby, they go on in this study to talk more about exactly what activities should be done at each stage of pregnancy and each stage of postpartum and also things to look for in your recovery. It's all really good. I just I'm not going to go over all of that in this podcast episode, because again, I want to leave time for my special guests, but I will link this study in the show notes if you want to go and look for yourself. But in conclusion, they talk about in this study without a slow and graded return to exercise, which is commonplace for other musculoskeletal events. The current paradigm may unintentionally be overly conservative in some respects during pregnancy, while not addressing dysfunction during the post partum recovery. Okay, so we might not be getting it quite right, by just doing a blanket statement of everyone of Oh, six weeks, you made it to six weeks. Yes, you're okay to start everything. And before six weeks, you should do nothing. Okay, that actually might not be a good fit for us all. So today, we're going to talk about what I wish I knew about postpartum exercise while I was in the postpartum period. And of course, you can probably guess that every body is going to be different and your body is going to be different after you have a baby. Not everything just goes back after the baby comes out. That's something I did not understand or anticipate with my first baby. So let's introduce today's podcast guest she is an expert in this area. Her name is Lara chambers. She works with peak wellness, and she teaches postpartum women how to reconnect with their core Oh, which is such a valuable thing to know how to do. So here's a little bit of an introduction to Lara. She was a former athlete turned recreational runner, and triathlete, she knows firsthand how it feels to have a postpartum body that doesn't feel quite as strong as it was before having kids. This turned her career focus from orthopedic physical therapy to pelvic health and pregnancy and postpartum corrective exercise. Refusing to accept refusing to accept the leaks, aches, and a new level of fitness as her norm. She got busy learning more about the changes that take place in the body during pregnancy, and the postpartum period. What she learned was transformative for her body and the way she approached postpartum exercise. Now feeling strong and confident in her body. Again, Laura is on a mission to empower others struggling with the same loss of confidence postpartum to reconnect with their core strength, and start living life as a core strong and competent mom. So I love that Laura is the girl after my own heart that just refused to be like, Oh, just peeing your pants when you run is just a normal part after you have babies. Nope. She did not accept that answer. And she dug for more. And I can't wait to share her with you. So without further ado, here is Laura
Bree, Hi, I am so honored to be on your show today. I feel like you give such wonderful resources to women at a phase of life where we're often under supported, under encouraged and sometimes just lost knowing if the next decision we make is going to be the right one or the wrong one. So thank you for the resources that you put out there. And thank you so much for allowing me on the show today. My name is Laura Chambers. I'm the founder of peak wellness and the creator of the core strong mom program where I get to teach postpartum women to reconnect with their core to reconnect with their competence in their body, and to learn that healing from issues like pelvic organ prolapse, postpartum incontinence and urine leaks, or just feeling like your body isn't working the way it used to before pregnancy and delivery goes way beyond key goals and we can look at the body holistically to bring a lot more healing and a lot more strength to the body. So a little about me, I got my doctorate in physical therapy from Duke University back in 2009. When I graduated, I went straight to an orthopedic clinical residency at my first job. After that I sat for my board specialization in orthopedics. And then I spent about the first 10 years of my career working in orthopedics. And even though I focus way more on postpartum healing at this phase of my career, I feel like my background in orthopedics really set me up for understanding tissue injury, and then reloading tissues and progressive ways after injury for optimal healing. And perhaps an equally important part of my educational journey was six years ago when I married my husband and became a stepmom. And almost five years ago when I delivered our first son, and two years after that, When I delivered our daughter, so I'd like to think my formal education, as well as my life experience qualifies me to speak to you today about what I wish I knew about postpartum exercise while I was breastfeeding. So a quick overview of what we'll discuss. First, I wish I knew my body wasn't ready for exercise as I knew it when I first had my baby. Second, I wish I knew to focus on reconnecting with my body. And third, I wish I knew that feeling stronger at my core would help my body be ready when the timing was actually right to get back to higher level exercise. So let's dive in. So what do I mean when I say I wish I knew my body wasn't ready to jump right back into the exercise I used to do. So here's how I thought postpartum recovery was going to go for me. My ego really wanted to just bounce right back and show the whole world that I hadn't been fazed by this whole pregnancy and delivery thing. I had seen other women who looked like they had seamlessly bounced back. And I thought for sure, in my athletic body, I was a collegiate athlete, I was an avid exerciser, I thought I would be right back there. And I honestly thought that after I birth the baby and went through the first few weeks of recovery, that my body was right back to normal and was ready to do those higher level things. But in reality, here's what I found. My body was different, and it couldn't handle what I was throwing at it. Alright, to clarify, it actually did handle it. As far as it went on the run, I told it to go on, it lifted the heavyweight, I told it to lift, but it wasn't doing it well. And now I had symptoms, I had some urine leaks. And I also had notable signs of pelvic organ prolapse, or feeling like there was something within my vaginal canal like a tampon or something when there really was nothing there. That should have been a clear sign to me that I was overdoing. But it's something that after my first baby I didn't listen to my time was also very different. Now, after having a baby, baby was my full time life. And the time that it took to nurse and then to pump was seemingly a full time job. Even when I was on maternity leave the our schedule really rotated around that. And that was something that was super important to me. So I wasn't willing to sacrifice it. But it did take a lot of time. And it did take a lot of my energy to make that milk and to make the schedule to make that happen. So here's a great example, I would often meet my friends to run at 530 in the morning before having kids. But now with a newborn, I had to get up at 4am If I was going to have time to poop, to nurse my baby, and then to pump which I was often doing to help make sure my supply stayed up. So if I was gonna get up at 4am, and then use the energy to go for a run, and then have enough energy to continue to make a good supply of milk for my baby, I was setting myself up for a process that was not sustainable. So what happened was, I would push it for a day or two or maybe even a week and I would make the running happen. And then I would fall back and be so tired that I would fall out of sync. And then I would feel so guilty, wondering why I wasn't able to stick to a routine. And honestly, I had such a fear in my head that I was going to lose my motivation to exercise. I had always identified myself as an athlete, exercising regularly was a key part of who I was. So I feared that if I took some time to recover, to really connect to my new baby to make time for our new growing family that I would not want to go back to what if I didn't pick up exercising again, that was a real fear in my head. And I'm happy to report now on the other side with an almost five and an almost three year old and I'm no longer breastfeeding that I am absolutely back to loving exercising, to prioritizing exercising, to pushing myself to meeting my friends. It didn't go away. I just had to wait till life headspace for it. So this second thing that I wish I knew, which was I needed to focus on reconnecting with my body wasn't something I recognized after my first. It wasn't until I spent a lot of time studying pelvic health and pelvic rehab that I really understood this. And so my recovery from my second birth was very different from my first at this point, I had learned about adaptations that my body had to make in order to accommodate a growing baby during pregnancy. So let's consider as that baby grows, it pushes up into the ribcage which does a couple things. One is pushing up into the diaphragm which normally would be our primary breathing muscle. But when the diaphragm is being smushed by growing baby, other muscles now have to kick in and compensate. The other thing that that does is limits the amount of movement that can happen in the ribcage and the thoracic spine. Another postural change from pregnancy as the belly grows, is the body tends to arch backwards just a little more so increasing the spinal curve. What this does to the center of gravity actually takes Some of the action out of our glutes, so later in pregnancy, the glutes become less active. And then I recognize in myself that I had really disconnected from my abs completely, my belly was growing at a rapid rate. And my body had kind of shut off my tendency to want to work and focus on my abs. And then of course, there's the obvious tissue injuries that can happen during childbirth. Now, often we don't talk about delivery as an injury process, because it is a very natural process, a woman's body is meant to deliver a baby. But even in the best of situations, we are taking tissues and joints, and stretching them to their absolute physiological maximum limit. So there's a lot of stretching. And then at the worst, there's various degrees of tearing, of cutting of re suturing things back together. So if we look at all the adaptations from pregnancy, all of the tissue changes from delivery, my assumption that my postpartum body was just the same as my pre pregnancy body and it was ready to go was very flawed. So reconnecting meant I needed to hone in on these key areas and say, Hmm, how's my body feeling? How's my body functioning? What do I need to help get my body back to what it was doing before pregnancy and before delivery. So let's talk through a few key areas that you can focus on. Let's start with the obvious the pelvic floor, it gets a lot of attention postpartum. So the first thing that I would have a woman do or have myself do is to mentally reconnect with the pelvic floor, when you try to do a pelvic floor contraction, often called the Kegel, what do you feel happening? Can you feel yourself squeeze those muscles? So squeezing as if you were trying to cut off the flow of urine? But not doing that regularly? While you are urinating you're doing this at a separate time? Can you contract those muscles and relax them and feel them contract in isolation from other muscles, so no inner thigh squeeze no butt squeeze just isolated pelvic floor. Once you can reconnect and actually feel them function, then you've got to answer an important question. Are my pelvic floor muscles underactive? Or are they actually overworking? We usually assume the pelvic floor muscles are underactive and weak. But I have seen time and time again in my career, pelvic floor muscles that are being way over active. And the confusing thing is an underactive or an overactive muscle can actually have similar symptoms, both of them can have outcomes of leaking urine, or have pelvic organ prolapse or tension feeling in the pelvic floor. So a way that I really like to help self assess this is doing the following exercise, sitting in a chair feet flat on the ground, try to contract your pelvic floor at about 25% effort, not a strong contraction, just a gentle one, and then let it go. You're staying relaxed. And then you're going to contract again, trying to contract at 50% effort. So roughly half your strength, and then let it go. Totally relaxed. Now contract to 75% effort, getting stronger with this contraction. Let it go all the way relax. Finally, a 100%. Nice big squeeze. Remember, no glutes inner thighs, nothing else contracts, just big squeeze, and then let it go. So assess it this way. Could you feel the let go of each phase of that contraction, if you could not, odds might be that your pelvic floor is overactive. So what you need to focus on is feeling the tiniest contraction you can perceive and then focus on letting that go. Being able to sense what does contraction and relaxation feel like. On the flip side, if you felt the relaxation phase, well, with each of those, you may need to work on building your control in the pelvic floor. Could you go from 2550 75 to 100%? Was one of them easier or harder than the other? Was it difficult to transition between those phases? I'm not usually all about Kegel, Kegel Kegel, go stronger, hold longer. But I do like to reconnect and learn that control. So working through that 25 All the way up to 100% might be a really good exercise to go through three or four times for someone with an underactive pelvic floor who's trying to reconnect more. The second muscle is the diaphragm. It lies directly above the pelvic floor anatomically. And it plays a key role in helping to manage the pressure within the abdomen. And that's what helps make sure there's not too much force that's being pressured down into the pelvic floor. Those pelvic muscles are really small. So if there's constantly high forces being pushed into them, they can't be strong enough to counterbalance all of that. So we need other muscle groups on board to help control those abdominal forces and the diaphragm is great at that. So let's do a check in to see how Your diaphragm is working. You're gonna take your hands, place them on either side of your lower ribcage. Now taken two big breaths.
One more. Now what did you feel if the diaphragm is working optimally, what you should feel is your lower ribs widen out pushing your hands out. But what can happen if the diaphragm is not the primary muscle working is you won't feel very much movement within the ribcage what you'll feel is more upper chest or the back arches or the shoulders tense up or the neck tenses up. Those are those extra breathing muscles that may have kicked in during pregnancy that are still in the habit of helping you breathe. So your exercise would be hands on the side of those low ribs. Focus on breathing in and trying to feel how your ribs can push out into your hands. Start with just five breaths, and try to check in five or more times during the day. So you keep remembering to use that diaphragm. And the final muscle group we'll talk about are your abdominals. And we're specifically going to talk about the deepest layer of abdominals. So not the sexy six pack muscles that you see on magazine covers, we're going deep. Here, there's four layers of ABS, we're going into the deepest one, these muscles create a corset of support around the spine and the pelvis. But they also do another really important function, they allow your pelvic floor to function optimally. To get that 100% contraction of the pelvic floor that we did in our test, you actually need some activation of this deepest layer of abdominals, your transversus abdominus. So let's talk about how you can check this muscle lie on your back feet on the floor. So your knees are bent up, you're going to take your fingers, put them on the bony front of your pelvis, so those bones that stick out in the front, and then move your fingers in towards the belly button just slightly, and it should feel soft and squishy. You're putting your hands here so you can feel when these deep abdominal muscles kick in. So when you're relaxed, it's soft and squishy. When you get a good contraction, you should feel it firm up under your hand. So the first thing you can try is doing a kegel, do a nice strong Kegel and see if when you get to those 75 and 100%, Kegel contractions. If you feel tensioning under your fingers, and then relax. Remember, you want that Kegel to fully relax. If you felt a contraction there, you're gonna do a few more really using your brain power to tune into those deep low abs. So you start to really process what they feel like when they work. If that's not working for you, try this other cue, think of those bones in the front of your pelvis. And think if there's a string connecting the two sides together, you're going to try to contract the muscles that would pull along that string and bring those bones together. And then relax. Try to contract against see if you feel tension under your fingers and let it go. These muscles can sometimes take my patients days and even weeks of practice to reconnect with if they're really tricky in the beginning. But I promise it is worth it. And these muscles really helped the whole core work together better. All right, and we've already alluded a bit to this third and final thing I wish I knew about exercise while breastfeeding. But that was to give myself grace, to know that feeling stronger in my core doing these reconnection exercises was really helping my body so that it was actually ready when the timing was right to get back to exercise. And that timing right was so key for me, I could not make a sustainable higher level exercise routine happen until I finished nursing my daughter. That was a good four and a half years between previous exercising, Laura, getting pregnant with my first still nursing when I got pregnant with my second and then finishing nursing my second, so it was a good time off for me. But when the time was right, I couldn't make it happen then. And after my second baby. If I hadn't laid the foundation nice and strongly, I would have struggled a lot more getting back into my regular fitness routine. But because I had done these things and my body was feeling ready to go, I was able to hit the ground running and it felt fantastic. Alright, so let's just do a quick recap of what I wish I knew about postpartum exercise while I was breastfeeding. So number one, I wish I understood my body wasn't ready for exercise as I used to do it. Number two, I wish I understood to focus on connecting to key parts of my body. Specifically today we talked about the pelvic floor, the diaphragm and the deepest layer of ABS. And number three I wish I understood that doing step number two and feeling stronger in my core was what was really going to set my body up to be ready for that higher level exercise when the timing was right. And that right timing did come good luck to all you mamas you got this right my friends isn't Laura. So great. I know today's episode is a little bit longer than we normally go with just so much good information in here. If you want more Lara in your life, she's at Dr. Dot Laura underscore peak wellness on Instagram. I will link that in the show notes. She's also at www.peakwellnesstn.com. She has a core strong mom online program that will help you if you're dealing with incontinence or prolapse postpartum. And I just love her holistic approach as she helps women get through this tricky postpartum period. So again, Laura's top three tips for number one. Skipping the rehab phase a postpartum exercise may set the body up for more difficulties when returning to exercise. Number two, focus on reconnecting to your pelvic floor and what it needs. diaphragm breathing, spinal mobility reconnecting to your glutes, the deepest layer of your abs. And tip number three was feeling strong and your core will help you be stronger when the timing is right. Thank you, Laura, so much for being a valuable guest on today's podcast episode. I hope that this was valuable to you listening today. If you love this episode, then hold on because there's going to be a brand new episode that comes out next week as well. I can't wait to share it with you. And of course I'm going to leave you with you're strong, you're smart, you're beautiful, you're a good friend to all buy. If you would like more help check us out at breezy babies.com Is the happy place for boobs and babies, where you can take an online workshop on topics from breastfeeding to baby gas. Learn baby massage, get a pumping plan before returning to work and even get one on one lactation help from our IBCLC we meet with families both in home and also all over the world via secure video and guess what? These lactation consultations might even be covered by your insurance. Click the link in the show notes or visit breezy babies.com to see if you qualify. Also connect with us at breezy babies on Instagram and YouTube. And last if you love what we do, please leave us a review on Google or Apple podcasts. Bye!

Summary

• Intro to the show. 0:00
  • Welcome to the breezy babies podcast.
  • Three things every postpartum exercise lover should know.
• Being a mentor and having a mentee. 2:48
  • Being a mentor and having a mentee is great.
  • Maximizing recovery in the postpartum period.
• The importance of staying active during and after pregnancy. 5:01
  • Staying active during and after pregnancy is important.
  • Musculoskeletal exams are rarely performed.
  • Musculoskeletal pain and urinary incontinence are common in postpartum.
  • Pelvic floor dysfunction.
• High-impact exercise increases risk of pelvic floor dysfunction. 9:37
  • High impact exercise increases risk of pelvic floor dysfunction five-fold.
  • What to do during postpartum
• Introduction to Laura chambers. 11:42
  • An introduction to Laura chambers, founder of peak wellness.
  • The core strong mom program.
  • Background in physical therapy and orthopedics.
  • What she wishes she knew about postpartum exercise.
• How my body couldn’t handle the workload. 16:19
  • Pelvic organ prolapse after having her first baby.
  • Connecting with her body after having a baby.
• Postpartum recovery and recovery from childbirth. 19:11
  • Adaptations to accommodate a growing baby during pregnancy.
  • Postpartum recovery from second birth.
• How to mentally reconnect with the pelvic floor. 21:22
  • Mentally reconnecting with the pelvic floor postpartum.
  • How to self-assess pelvic floor muscles.
  • Feeling the tiniest contraction and relaxation phase.
  • Diaphragm check-in to see if it's working optimally.
• The deepest layer of abdominals. 26:04
  • The deepest layer of abdominals, the transversus abdominus.
  • How to check the deep abdominal muscles.
• What I wish I knew about exercise while breastfeeding. 28:05
  • What Laura wishes she knew about postpartum exercise while breastfeeding.
  • Connecting to key parts of the body.
  • Laura's top three tips for postpartum recovery.
  • Breezy babies, the happy place for breastfeeding.